Diagnosis Of Parkinson's
How long will I have Parkinson's before people notice?
People could have symptoms of Parkinsons disease for quite some time before it becomes conspicuous either to themselves or others around them. It could be a period of even a year or two. Sometimes when people have symptoms they start seeking medical attention for vague symptoms as aching of their limbs or just a sense of general not feeling well. There was a study years ago that indicated that on average people were seeing doctors for these kinds of complaints for about two years. The disease itself is probably starting years before the conspicuous manifestation such as tremor. We really don't know how long that period of time is, but there is something happening long before it becomes obvious to people. It's an interesting question, but we don't know exactly how long that time interval is.
When should I see a doctor about Parkinson's disease-like symptoms?
If they're having symptoms that are of concern to either themself or to their spouse or others around them, they should seek medical attention to try to figure out what the problem might represent. There's increasing evidence that early intervention in Parkinsons disease may have a favorable long-term outcome. People who delay treatment, for example, for extended periods of time, lose something that can't be regained by seeking or receiving treatment at a much later date.
What questions does a doctor ask to test for Parkinson's?
When seeing someone for the first time, I would ask them frankly about tremor. I would also ask, particularly the spouse, and I hope the spouse is present at the initial visit, I would ask about any kind of perceived change of voice, of speech volume, of clarity of speech. I would ask about mobility issues. I would ask the patient whether they are having difficulty with fastening these small buttons. Has their handwriting changed? Because again, the handwriting change does occur commonly, and early on. I would ask about walking. Are they having difficulty with walking? Do they tend to drag a foot? I would ask about postural changes. And then again, overall mobility in general. Has the patient, or their spouse, or others close to them, noticed any change in mobility?
What tests are used to diagnose Parkinson's?
There are no diagnostic tests that confirm or rule out the diagnosis of Parkinson's Disease. The diagnosis is based upon the history of the questions that I elicit, the answers that I elicit from my question and the patient, also the findings on the physical examination, things that I actually do, moving them about and observing them while I am talking and so forth. In some cases, I might request brain imaging such as an MRI but routinely not. It would only be if somebody had unusual findings on the examination or if some of their symptoms didn't quite make sense to me. I might think about requesting a brain MRI or perhaps a CAT Scan. Otherwise I don't do tests for somebody that has a history, meaning their symptoms and examination are consistent with their diagnosis. I wouldn't do additional testing.
What is the physical exam used to test for Parkinson'?
On the physical examination, especially at the time of the first visit, I would be assessing the tone of their neck, arms and legs in a very specific fashion. Again, looking for subtle changes, but perhaps by moving a limb on the other side while I'm checking for change of tone of, say, their their left arm while I'm moving their right arm. I would also look for changes of dexterity with things like finger tapping, hand opening or closing or alternating hand movements to see if there's any change in the patient from right versus left, for example. I would, in most cases, complete a general neurological examination checking reflexes, tapping on the knees and the arms and so forth; and scratching peoples feet. These are part of a standard neurological examination. In most cases, for somebody where I'm suspicious of a diagnosis of Parkinsons disease, I'm going to be focusing on the motor components, meaning the tone and mobility in general. I also watch people walk, which I find is a very important component of the neurological examination. In that, I look for symmetry of shoulder height and arm swing. I also check peoples balance. Again, early on in Parkinsons disease, balance is usually not an issue. But I do check it nonetheless. It's part of the standard Parkinsons examination. I will stand behind them and pull on their shoulders abruptly to see if they have any difficulty with posture or stability. Do I need to catch them? Or, do I need to hold them up? Or, do they take a step backward?
Is there a cure for Parkinson's?
There is no cure for Parkinsons disease. But, I have to add, that is true for so much of medicine. There are few things that we actually cure. We treat most things, and that is also the case with Parkinsons disease. There's no method now, either surgical or using medications to just stop it, to eliminate it, to make it go away, unfortunately. However, we are able to successfully treat it in most cases.
